Background: Primary Health Care plays an important role in the provision and coordination of palliative care in many healthcare contexts. Education and training of healthcare professionals are relevant strategies to support the delivery of quality palliative care. Objective: To evaluate whether training healthcare professionals working in Primary Health Care improves symptom assessment and clinical management of patients eligible for palliative care. Methodology: Systematic review conducted according to PRISMA 2020 guidelines, with a protocol registered on the PROSPERO platform under the number CRD420261370621. The eligibility criteria were structured according to the PICO approach: population composed of healthcare professionals working in primary care; educational interventions in palliative care; comparator without training or with different modalities; outcomes of symptom assessment and clinical control. The searches were conducted in seven databases: PubMed/MEDLINE, Embase, Web of Science, Scopus, Cochrane Library, SciELO, and LILACS. Results: Eight studies were included in the review, with varied designs: a pilot randomized clinical trial, a quasi-experimental study, two evaluations of educational programs, a feasibility study, a retrospective population cohort, and two qualitative approaches. The findings revealed a generalist predominance in the provision of palliative care: 95% of the care was provided by generalists, 53% of patients did not receive identifiable palliative care in the last year of life, and specialists were virtually nonexistent in rural areas, where family doctors were responsible for nearly all care. Conclusions: Training of primary care teams is necessary, but insufficient on its own. Although it improves the confidence and knowledge of professionals, there is no robust evidence that it sustainably transforms patient clinical outcomes. The problem is structural: there is a lack of adequate clinical time, compatible remuneration, integration with specialists, and support infrastructure. It is necessary to go beyond education and promote reforms in the healthcare system so that palliative care in primary care is effectively qualified.
Background/Objectives: In breast cancer patients with limited nodal burden, sentinel lymph node biopsy (SLNB) alone, without axillary lymph node dissection (ALND), has shown non-inferior survival. However, it remains unclear how many SLNs should be harvested. We aimed to determine if the number of harvested SLNs and the use of a single agent for SLNB localisation affect the detection of residual metastatic nodes. We also described the oncological outcome of SLNB alone as an exploratory clinical outcome. Methods: From 1 January 2020 to 31 January 2026, T1–2 patients and 1–2 metastatic SLNs who underwent SLNB only or with completion ALND were analysed. The number of SLNs harvested and the use of single or dual agents for localisation of SLNs were analysed in the ALND group to determine if it affected the detection of residual metastatic nodes. Data on oncological outcomes were reported. Results: A total of 152 patients were enrolled, of which 63 and 89 underwent SLNB alone and ALND respectively. The ALND group had more patients with mastectomy (p = 0.0044), macrometastasis (p = 0.0001) and no radiation to the axilla (p = 0.0001). Median number of harvested SLNs was 3 (range: 1–8) and 2 (range: 1–9) in the SLNB and ALND groups respectively. In the ALND group, a mean residual 2.4 metastatic nodes (range: 1–9) was seen in 24.7%. Multivariable logistic regression showed that a higher SLN yield was not associated with less residual disease (adjusted OR 0.71 per additional SLN, 95% CI [0.46, 1.12]). Conversely, the number of metastatic SLNs was statistically associated with residual nodal disease OR 3.6 95% CI [1.19, 10.86]. Single-agent SLNB localisation (mainly patent blue dye) was used in 22% and 19.3% of SLNB and ALND group respectively. Though dual-agent localisation had more patients with ≥2 SLNs (p = 0.0181), it was not statistically associated with residual nodal metastatic disease which occurred in 7/17 (41.2%) single-agent versus 15/71 (21.1%) dual-agent cases (p = 0.1184; OR 2.58, 95% CI [0.71, 9.09]). No recurrences were observed on a median follow-up of 37 (range: 3–75) months. Conclusions: The number of harvested SLNs and the use of patent blue dye as a single-agent localisation were not statistically associated with residual nodal disease in patients with limited nodal burden. Instead, metastatic SLN burden was statistically significant for residual nodal disease. However, our findings were limited by small sample size and should be considered as exploratory in nature with validation needed in larger studies with longer follow-up.
Background: Maternal obesity is associated with pregnancy complications and adverse perinatal outcomes, although observational associations may be influenced by confounding, exposure ascertainment, and missing data. This study investigated associations between recorded maternal body mass index (BMI) and maternal clinical conditions, obstetric complications, delivery characteristics, and perinatal outcomes in a referral center. Methods: A retrospective study was conducted using medical records of pregnant women at a referral center. Recorded maternal BMI categories were classified according to the World Health Organization. Database standardization harmonized equivalent diagnostic terms, preserved maternal clinical conditions and obstetric complications as separate domains, and grouped uncommon conditions for descriptive and exploratory analyses. Missing non-BMI variables underwent multiple imputation across 50 completed datasets; maternal BMI was not imputed. Twin pregnancies were excluded, and women with and without recorded BMI were compared before and after imputation. All singleton pregnancies with recorded BMI were included descriptively, whereas association analyses excluded women with underweight because of their small number and absence of recorded primary-outcome events. The primary composite perinatal outcome comprised neonatal intensive care unit admission, recorded fetal death or stillbirth, or a 5-min Apgar score <7 among liveborn infants. Logistic regression models compared overweight and obesity with normal weight, adjusting for maternal age and parity. Selected outcomes underwent additional adjustment for smoking, chronic hypertension, and pre-existing diabetes mellitus. Complete-case analyses assessed the sensitivity of the core findings. Results: The source database comprised 1012 records. After excluding 13 twin pregnancies, 999 singleton pregnancies remained; BMI was recorded for 787 women and missing for 212 (21.2%). Among women with recorded BMI, 27 (3.4%) had underweight, 282 (35.8%) normal weight, 210 (26.7%) overweight, and 268 (34.1%) obesity. Association analyses included 760 women. Compared with normal weight, obesity was associated with maternal clinical conditions (adjusted odds ratio, 3.04; 95% confidence interval, 2.06–4.49), chronic hypertension (8.96; 4.14–19.38), obstetric complications (4.12; 2.83–5.99), hypertensive disorders of pregnancy (6.12; 3.60–10.40), gestational diabetes mellitus (2.43; 1.48–3.97), cesarean delivery (3.18; 2.12–4.75), and large-for-gestational-age birth (5.99; 2.74–13.13). Overweight was also associated with obstetric complications, gestational diabetes mellitus, cesarean delivery, and large-for-gestational-age birth. The associations between obesity and overall obstetric complications, hypertensive disorders of pregnancy, and large-for-gestational-age birth remained evident in expanded models. No statistically significant association was observed with the primary composite outcome for overweight (0.58; 0.21–1.57) or obesity (1.16; 0.54–2.53), and complete-case analyses were similarly inconclusive. Core models did not identify statistically significant associations with preterm birth, small-for-gestational-age birth, or low birth weight. The exploratory association with perineal tears was attenuated after adjustment. Women without recorded BMI had fewer recorded maternal clinical conditions, obstetric complications, and cesarean deliveries, but more composite perinatal events; these differences persisted after imputation. Conclusions: Higher recorded maternal BMI was associated with maternal morbidity, cesarean delivery, and large-for-gestational-age birth after adjustment for age and parity. The composite perinatal findings remained inconclusive because of limited event frequency and imprecise estimates, rather than demonstrating absence of increased risk. Differences according to BMI availability indicate potential selection bias, while uncertain exposure timing and residual confounding further constrain interpretation. The findings support individualized preconception and antenatal assessment and standardized clinical documentation, without establishing causal relationships or the effectiveness of a specific intervention.
Background: Transthoracic echocardiography (TTE) is the first-line imaging modality in neonates and infants with congenital heart disease (CHD), whereas cardiovascular computed tomography (CCT) is generally reserved for selected questions that remain unresolved after echocardiography. We evaluated the incremental diagnostic contribution of CCT within this multimodality imaging pathway. Methods: We retrospectively reviewed consecutive patients aged <1 year with CHD who underwent CCT after multidisciplinary review because TTE was inconclusive or additional anatomic definition was required for surgical planning. The primary endpoint was the incremental anatomic information provided by CCT beyond TTE. Secondary analyses included diagnostic performance against operative findings, acquisition characteristics, radiation exposure, contrast administration, and procedural safety. Results: Twenty-six patients were included; 14 (53.8%) were neonates. CCT was requested most frequently to assess coronary anatomy (9/26, 38.5%), followed by the pulmonary veins (4/26, 15.4%), aortic arch (3/26, 11.5%), and pulmonary arteries/MAPCAs (4/26, 15.4%). CCT provided additional anatomic characterization in 14/26 patients (53.8%), predominantly involving extracardiac vascular structures, and was discordant with TTE regarding the unresolved target anatomy in 12/26 (46.2%). Against the operative findings, TTE accuracy was 96.2% for intracardiac abnormalities, 41.2% for extracardiac abnormalities, and 11.1% for coronary abnormalities; corresponding CCT accuracy was 100%, 94.1%, and 100%. CCT directly informed the surgical approach in two patients with total anomalous pulmonary venous drainage. All examinations provided sufficient image quality to address the specific clinical question for which CCT was performed, and no contrast-related adverse events occurred. The median estimated effective dose was 3.62 mSv (IQR, 1.94–6.06). Conclusions: In a highly selected cohort of neonates and infants with CHD in whom expert TTE leaves a clinically relevant question unresolved, CCT may provide incremental information, particularly regarding coronary and extracardiac vascular anatomy. These findings support a targeted multimodality strategy in which CCT complements echocardiography and is tailored to the anatomic question relevant to surgical planning.
Background: Appendiceal epithelial lesions are rare and heterogeneous. Evidence regarding vascular endothelial growth factor A (VEGF-A) expression in localized appendiceal lesions is limited. We compared VEGF-A immunoreactivity across diagnostic subtypes and explored associations with histological features. Methods: This retrospective exploratory study included 73 appendiceal neoplastic epithelial lesions. Formalin-fixed, paraffin-embedded tissue was assessed for predominant VEGF-A staining intensity and percentage of positive neoplastic epithelial cells. Their product was reported as a modified immunoreactivity score (0–300). Permutation-based nonparametric tests, Benjamini–Hochberg correction, diagnosis-adjusted sensitivity analyses, and interobserver agreement analyses were used. Results: VEGF-A staining was present in 71/73 cases. Median immunoreactivity scores were 205 for adenocarcinoma, 170 for hyperplastic polyp, 180 for low-grade appendiceal mucinous neoplasm, and 100 for sessile serrated lesion; the overall difference was not significant (p = 0.073). No histological-feature association remained significant after false-discovery-rate correction. Surface nuclear stratification was not significant in the global analysis (p = 0.051; q = 0.169), and after diagnosis adjustment (p = 0.282). VEGF-A measures did not differ between acute and incidental presentations; patients with acute presentations were younger (p = 0.006). Conclusions: VEGF-A immunoreactivity was common, but no robust subtype-specific or histology-specific pattern was identified. These exploratory findings do not establish clinical utility and require confirmation in larger controlled cohorts.
